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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTM" T Page 1 <br /> 304 E WEBER AVE -3RD FLOOR <br /> STOCKTON, CA 9520 <br /> <br /> AccountlD AR0017815 <br /> Facility ID FA0010815 <br /> Date Printed 2/25/2005 <br /> COUNTRY CLUB CLEANERS RE : COUNTRY CLUB CLEANERS <br /> 1901 COUNTRY CLUB BLVD 1901 COUNTRY CLUB BLVD <br /> STOCKTON, CA 9 204 STOCKTON, CA 95204-4821 <br /> OWNER : KITTO,JEFF <br /> Date Health <br /> Program Descriptio Amount <br /> Invoice# IN0128377---Date of Invoice: /24/2005 11111 111111111111111 IN 111111 11111 1111 1111 <br /> 1/24/2005 2220 SM HW G N<5 TONS/YR $ 200.00 <br /> 1/24/2005 2399 UNIFIED OGRAM FAC STATE SERVICE FEE $ 24.00 <br /> Total for this Invoice $ 224.00 <br /> Payment Due Date 2/23/2 <br /> TOTAL DUE this Billing Period $ 224.00 <br /> ti � .^ ■k <br /> PAYMENT <br /> RECEIVED <br /> MAR 1 1 2005 <br /> SAN JOAGUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Please make Checks PA ABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For OES/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5255.rpt <br />